Journal of Reconstructive Urology

.: ORIGINAL RESEARCH
Predictive Factors of Pathological Upgrading in Prostate Cancer Patients Treated by Radical Prostatectomy Who are Suitable for Active Surveillance
Aktif İzlem İçin Uygun Olan ve Radikal Prostatektomi ile Tedavi Edilen Prostat Kanserli Hastalarda Patolojik Yükselmeyi Gösteren Prediktif Faktörler
Erkan MERDERa, Ahmet ARIMANa, Muammer BOZKURTb, Osman CANb, Erdal ABAYa, Mehmet Gökhan ÇULHAa, Recep Burak DEĞİRMENTEPEc, Musab Ümeyir KARAKANLIa, Fatih ALTUNRENDEa
aDepartment of Urology, University of Health Sciences Prof. Dr. Cemil Taşcıoğlu City Hospital, İstanbul, TURKEY
bClinic of Urology, Başakşehir Çam and Sakura City Hospital, İstanbul, TURKEY
cClinic of Urology, Karasu State Hospital, Sakarya, TURKEY
J Reconstr Urol. 2021;11(3):103-10
doi: 10.5336/urology.2021-84243
Article Language: EN
Full Text
ABSTRACT
 Objective: To evaluate the factors to predict Gleason score upgrading in prostate cancer patients who are suitable for active surveillance (AS) and the role of prostate-specific antigen (PSA) density in the management of these patients. Material and Methods: Seventy seven prostate cancer patients who had active surveillance criteria but preferred radical prostatectomy as the treatment instead of active surveillance protocol were included in the study. In our study, Gleason 3+3≤6 adenocarcinoma, positivity in maximum 2 biopsy cores in ≥12 core transrectal ultrasound guided systematic biopsy, PSA<10 ng/mL, and Clinical T Stage ≤2a were used as active follow-up criteria. Tumor grade in the radical prostate and prostate biopsy specimens were compared. Predictive factors of pathological upgrading after radical prostatectomy have been investigated. Results: There is statistically significant correlation between PSA density (p=0.042), prostate volume (p=0.010), maximum tumor length in a core (p=0.001), maximum percentage of tumor in a core (p=0.002), bladder neck involvement (p=0.023) and postoperative Gleason score upgrading in univariate analysis. The optimal cut-off values of PSA density and prostate volume were 0.12 ng/mL2 and 48 cc, respectively. There isn't statistically significant correlation between PSA, free PSA, free/total PSA, the length of biopsy core, perineural invasion, apical involment and postoperative Gleason score upgrading in univariate analysis. Maximum tumor length in a core and prostate volume were independent predictors of pathological Gleason score upgrading on multivariate regression. Conclusion: Prostate volume and maximum tumor length in a core are independent predictors of pathological Gleason score upgrading in our study. These factors should also be included in current AS criterias in addition to PSA density and tumor percentage.

Keywords: Prostate specific antigen density; active surveillance; Gleason score upgrading; low risk prostate cancer; radical prostatectomy
ÖZET
 Amaç: Bu çalışmanın amacı, aktif izlem için uygun prostat kanseri hastalarında Gleason skor yükselmesini öngören faktörler ve bu hastaların yönetiminde prostat spesifik antijen (PSA) yoğunluğunun rolünü değerlendirilmektir. Gereç ve Yöntemler: Çalışmaya aktif izlem kriterlerine sahip olan ancak tedavi olarak aktif izlem yerine radikal prostatektomiyi tercih eden 77 prostat kanseri hastası dâhil edildi. Çalışmamızda, aktif izlem kriterleri olarak Gleason 3+3≤6 adenokarsinom, ≥12 kor transrektal ultrason kılavuzluğunda sistematik biyopside en fazla 2 biyopsi korunda pozitiflik, PSA<10 ng/mL ve Klinik T Evre ≤2a değerleri kullanılmıştır. Radikal prostatektomi piyesleri ve prostat biyopsi örneklerindeki tümör dereceleri birbiriyle karşılaştırılmıştır. Radikal prostatektomi sonrası patolojik evre yükselmesi ile ilgili prediktif faktörler araştırılmıştır. Bulgular: PSA yoğunluğu (p=0,042), prostat hacmi (p=0,010), bir kordaki maksimum tümör uzunluğu (p=0,001), bir kordaki maksimum tümör yüzdesi (p=0,002), mesane boynu tutulumu (p=0.023) ile Gleason skor yükselmesi arasında tek değişkenli analizde istatistiki olarak anlamlı fark bulundu. PSA yoğunluğu ve prostat hacminin optimal 'kesme' değeri sırasıyla 0,12 ng/mL2 ve 48 cc idi. Tek değişkenli analizde PSA, serbest PSA, serbest/total PSA, biyopsi kor uzunluğu, perinöral invazyon, apikal tutulum ile postoperatif Gleason skor yükselmesi arasında istatistiksel olarak anlamlı bir ilişki yoktur. Bir kordaki maksimum tümör uzunluğu ve prostat hacmi çok değişkenli regresyon analizinde Gleason skor yükselmesinde bağımsız prediktif faktör olarak tespit edilmiştir. Sonuç: Çalışmamızda prostat hacmi ve bir kordaki maksimum tümör uzunluğu, Gleason skor yükselmesinde bağımsız prediktör olarak tespit edilmiştir. Bu faktörler, PSA yoğunluğu ve tümör yüzdesine ek olarak mevcut aktif izlem kriterlerine de dâhil edilmelidir.

Anahtar Kelimeler: Prostat spesifik antijen dansitesi; aktif izlem; Gleason skor yükselmesi; düşük riskli prostat kanseri; radikal prostatektomi
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